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But Lejeune could not stop what he had unwittingly begun. By the summer of 1967, the American Medical Association had passed a resolution endorsing abortion in cases in which "an infant may be born with incapacitating physical deformity or mental deficiency." A year later, the American College of Obstetricians and Gynecologists came out with a similar policy. A number of states, years before Roe v. Wade, followed suit with laws allowing abortion for the purpose of eliminating children with mental defects, including Down Syndrome.

During the 1970s, genetic testing of pregnant women became routine, a practice encouraged by groups like Planned Parenthood. Since it is an invasive procedure that entails extracting amniotic fluid with a needle from around the child, amniocentesis (like its alternative, chorionic villous sampling) carries a significant risk of miscarriage, in some places as high as one in 100. As a result, the test generally has been reserved for use by women over the age of 34, who are more willing to weigh the risk against that of having a child with Down Syndrome. (The incidence of Down Syndrome increases with maternal age, from about one in 2,000 births at age 20 to one in 10 at age 49.) In 1984, however, it was discovered that a non-invasive blood test could be used to calculate the likelihood of bearing a Down Syndrome child. The blood test made it possible to provide screening for Down Syndrome to women of all ages at no risk to the mother. In 1986, the State of California began requiring physicians to offer the tests to pregnant women. The state's health department now funds much of the screening itself, spending $ 56 million a year to detect prenatal birth defects.

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The rest of the country followed California's lead. Between 1988 and 1993, the number of pregnant women who received blood tests for Down Syndrome doubled, to about 2 million. Almost all the tests were covered by private health insurance or Medicaid. Last year, the American College of Obstetricians and Gynecologists officially recommended Down Syndrome screening for all pregnant women. Although there is no cure or prevention for Down Syndrome -- indeed, the only real intervention that can be taken after a positive test result is abortion -- prenatal screening is now, in effect, mandatory. Few physicians, regardless of their beliefs on the subject, are willing to risk not offering the test, for fear of being slapped with a " wrongful birth" suit if a handicapped child is born. It has happened, repeatedly.

The rapid growth of prenatal testing has had some undeniably positive effects: A woman who knows she will bear a child with a handicap can plan to deliver in a hospital equipped for risky births. And many couples prefer the opportunity to prepare psychologically for the work of raising a disabled child. By far the most profound effect of prenatal testing, however, has been a staggering increase in the number of abortions.

The trend is clear: More testing invariably leads to more -- many more -- abortions of Down Syndrome children. "Most women who have children with Down Syndrome did not have the amnio," says Lori Atkins of the National Down Syndrome Society, and there is growing evidence to indicate this is true. A study of data from selected states by the Centers for Disease Control found that the rate of Down Syndrome births to mothers 35 or older dropped by about a third between 1983 and 1990. Another study, conducted over a slightly longer period, pegged the decline at 46 percent.

Larry Edmunds, a CDC statistician who is among the country's acknowledged experts on birth-defect trends, cites data from the 1980s suggesting that abortion reduced the number of children with Down Syndrome born to white women over 35 in the metropolitan Atlanta area by about 70 percent. Of the 30 percent in that study who did bear children with Down Syndrome, Edmunds explains, "those were mainly women who didn't have the test." *